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14 NOVEMBER 2014

NHS Innovation Diffusion: digital tools and social movements

"There is innovation inside the NHS. But innovations tend to stay local, failing to be adopted by other healthcare organisations or diffusing very slowly. This challenge is well recognised. But what's the problem? Given the assembled talents and good intentions of NHS staff, how can the systemic sum of innovation be so much less than its parts?

The NHS is sometimes described in terms of it's hierarchical structure. For my purposes it's useful to describe the current NHS using the language of philosopher–activists Deleuze & Guattari. In their terms, the NHS is a striated space marked by linear boundaries, restricted to a particular plane of activity in the space of all possible potentials[1]. For Deleuze & Guattari, like Foucault before them, power does not simply operate as a pyramid but in myriad multifaceted directions and relationships. Foucault said 'One doesn't have a power which is only in the hands of one person who exercises it alone... it is a machine in which everyone is caught, those who exercise power as much as those over whom it is exercised.. it becomes a machinery that noone owns'[2]. The overall effect is an institutional environment that acts to tame energies it is a social machine that produces conformity. As Deleuze & Guattari would say, the NHS is highly codified, where a code is a pattern of repeated acts. Of course, there are many situations where this is desirable–an ICU emergency needs a practiced response. But it doesn't make for a system that diffuses innovation.

Anyone who's returned from an innovation workshop and tried to applied new ideas in their NHS workplace has experienced this striation. It's the overlap in particular experience of all the dynamics that limit change: lack of autonomy in a hierarchical structure, the expectations of colleagues, the time it takes to deliver your daily targets, the lack of incentive, the lack of peer support, lack of sense of entitlement to change the way things are done all of which can combine to deliver an experiential straitjacket which is an impersonal affect, a pattern across the system and one that stifles diffusion as effectively as individual innovation.

The alternative is a system marked by flows, connections and zones of intensity. In the abstract terminology of Deleuze & Guattari, an innovative system would include smooth as well as striated spaces. Smooth space is occupied by intensities and events, by the continuous variation of free action. The characteristic experience of smooth space is short term, up close, with no fixed points of reference. I will try to show how the combination of social movements and digital technologies could blend smooth space with the more rigid boundaries and caste structures of the NHS in a way that aids the spread of innovation."

(Dan McQuillan, 2011)

[1] Deleuze, Gilles and Félix Guattari (1980). A Thousand Plateaus. Trans. Brian Massumi. London and New York:Continuum, 2004.
[2] Foucault, Michel (1975). Discipline and Punish: the Birth of the Prison, New York: Random House.

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TAGS

2011 • a practiced response • an impersonal affect • change the way things are done • codified • conformityconnections • continuous variation • Dan McQuillan • diffusion • digital movements • digital technologiesevents • expectations of colleagues • experiential straitjacket • Felix Guattariflows • free action • Gilles Deleuze • healthcare organisations • hierarchical structure • ICU emergency • individual innovation • innovation diffusion • innovation workshop • innovative system • institutional environment • intensities • lack of autonomy • lack of incentive • limiting change • linear boundaries • local innovation • machinery • Michel Foucault • myriad multifaceted directions • myriad multifaceted relationships • NHS • no fixed points of reference • ownership • particular plane of activity • peer support • philosopher-activists • power • pyramid structure • sense of entitlement • short term • smooth spacesocial computing • social machine • social movements • spread innovation • striated space • striation • up close • zones of intensity

CONTRIBUTOR

Simon Perkins
17 JULY 2012

Learning Communities: new students sharing common experiences

"In their most basic form, learning communities employ a kind of co–registration or block scheduling that enables students to take courses together. The same students register for two or more courses, forming a sort of study team. In a few cases this may mean sharing the entire first–semester curriculum together so that all new students in that learning community are studying the same material. Sometimes it will link all freshmen by tying two courses together for all – most typically a course in writing with a course in selected literature, or biographies, or current social problems. In the larger universities such as the University of Oregon and the University of Washington, students in a learning community attend lectures with 200–300 other students but stay together for a smaller discussion section (Freshman Interest Group) led by a graduate student or upper division student. In a very different setting, Seattle Central Community College students in the Coordinated Studies Program take all their courses together in one block of time so that the community meets two or three times a week for four to six hours at a time."

(Vincent Tinto, 1997, p.2)

1). Vincent Tinto (1997). "Universities as Learning Organizations", About Campus 1(6) January/February 1997, Wiley Periodicals, Inc. [http://onlinelibrary.wiley.com/doi/10.1002/abc.v1:6/issuetoc]

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TAGS

1997 • block of time • block scheduling • co-learner • co-registration • common experiencescommunitycourseempathy • first-semester curriculum • Freshman Interest Group • freshmen • graduate student • HEisolationlearners • learning communities • learning communitylearning journey • learning organisations • learning organizations • learning supportlinked • new students • pedagogypeer engagementpeer supportpersonal learning networksregistration • same material • Seattle Central Community College • shared experienceshared interestsshared understandingsharingsharing experiencessocial fragmentation • stay together • student cohort • students • study team • studyingsupport • taking courses together • timetable • timetabling • together • tying courses together • universitiesUniversity of Oregon • University of Washington • upper division student • Vincent Tinto

CONTRIBUTOR

Simon Perkins
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